There are a lot of questions and concerns in regards to the North Fork clinics with the recent event of the clinics being "handed back to Drs. Hundley and Meilner." Everyone seems excited by this, but most people do not quite understand what it takes to run a clinic and why the hospital stepped in to begin with.

As physicians, they don't teach us the business side of things in medical school or in residency. A few programs have added an MBA as part of your education that you can opt to take but this is something new in the last 10-15 years. Most medical students don't ever think they are going to be stuck trying to figure out how to negotiate a contract, set up payment agreements with insurance companies, or read financial reports.

What I have learned through school, residency, owning a practice, and being an employee in a practice is that I don't have near enough education to understand all of this. What I do understand is that to start a practice you need a building, staff, utility expenses, malpractice insurance, property insurance, contracts with insurance companies on what rate of reimbursement they agree to give you (and then someone in billing or collections to call and fight for that money that they try not to give you), and most importantly, startup funds for all of this. Being a service profession, you need at LEAST 3-6 months of startup funds to cover all of this while you begin to collect from insurance companies, patients, work comp, etc.

After it is all said and done, you end up writing off a minimum of $5,000/month in collections, bad debt, and charity care as you know patients cannot afford it and pretty soon your profit margin is near zero. Then you add in that you have to pay for electronic medical records (EMR) as this is mandatory by the government and if you don't meet their deadlines with a software system that meets all of their requirements, they will deduct 1 percent from collections they are willing to give you and that percentage grows every year until you can meet their requirements (most of these systems average more than $100,000 and then you have a monthly fee for tech support and you still have to pay for all of the hardware and IT to run it). Your profit margin just went in the negative. That means you have to cut expenses somewhere. If you cut salaries, staff leave, get unhappy, productivity goes down. Patients do not receive the care they need or deserve. You then try to see more patients in a day so you can bill out more for the month but they don't get the time with you they need. You do not have the time to complete charts or paperwork, you work extended hours in office and then end up working another 2-3 hours at home trying to stay on top of all of this as you feel responsible for the health of not only your patients, but for the livelihood of your employees and your business.

Your stress level is constantly through the roof. If you are lucky, you have time to eat healthy and attempt a little exercise every day, but not enough to keep the weight you preach to your patients about keeping off. You are likely battling with high blood pressure from the stress and possibly even on an antidepressant of some sort so you can deal with the stress of your everyday life. If you get sick, you ignore it as you don't have time to be sick. If you need surgery, you put it off as you can't afford to take the time off.

With all of this you can see why so many small rural clinics are closing their doors. You can maybe glimpse why doctors and nurses with a passion to care for people are changing careers despite loan debt. Burnout is becoming a much bigger problem than it ever was in the past for everyone in the field as they are being asked to perform at 210 percent every day for 10-12 hours a day and only being paid for eight hours of 100 percent performance and never being told thank you or good job, just do more, your best isn't enough. It is a vicious cycle that is getting worse, not better. The small town rural clinics are invaluable to their communities, but are becoming more and more rare due to these problems. The ones that are hanging on need the support and understanding of their communities while trying to find ways to keep the clinics alive as well.

In regards to the North Fork clinics -- a year ago when we approached the hospital for help, there were reasons we needed help. Those reasons have not changed and now we are back to trying to figure out a way to keep the clinics alive and going. I ask you all to be patient while we try to figure this out. It is our goal to continue to provide care to this area at the best of our ability, but we cannot do it at the expense of our families or our health. Don't give up on us, just bear with us.

In regards to who will be here to care for patients -- with the current situation Dr. Meilner will be staying and I, Dr. Hundley, will be going to the VA. With the changes that need to be made and not being able to come up with startup funds in less than two weeks, the clinic cannot support a skeleton staff and both of our incomes. I will do what I can to help Dr. Meilner with the endeavors of the clinics as best as I can. This has not been an easy decision and resulted in many sleepless nights and several bottles of antacids. Again, I ask of you all to bear with us in this change and be patient while we work out all the kinks to get things up and running smoothly again. Thank you.